Clinical features of 7 cases of pure spinal epidural cavernous hemangioma / 中国医师进修杂志

Objective:To study the clinical features of pure spinal epidural cavernous hemangioma in order to improve the diagnosis and treatment ability.Methods:The clinical data of 7 patients with pure spinal epidural cavernous hemangioma from January 2013 to November 2022 in Xiangyang Central Hospital were analyzed retrospectively.Results:Among the 7 patients, 2 males and 5 females, and the average age was 49.4 years old. Location of the lesion: cervical spine 1 case, thoracic spine 5 cases, and lumbar spine 1 case. One patient had pure radicular symptoms, 4 patients had pure spinal cord symptoms, and the other 2 patients had both myelopathy symptoms and radicular symptoms. T 1 and T 2 weighted images showed equal or slightly longer signals, and the enhanced scans showed uniform enhancement. Before operation, 1 case was misdiagnosed as meningioma, and the patient′s lesion was not carefully identified during operation, so the lesion was mistaken for oozing hemorrhage caused by operation; 2 cases were misdiagnosed as schwannoma. All patients underwent preoperative localization and microsurgical resection of epidural lesions through the posterior median approach. The lesions were completely removed and no significant complications were observed during hospitalization. Before operation, the neurological function Frankel grade C was in 1 case, grade D in 3 cases, grade E in 3 cases; the patients were followed up for 1 to 117 months, at the last follow-up, neurological function Frankel grade D was in 3 cases, grade E in 4 cases, no recurrence was found. Conclusions:The pure spinal epidural cavernous hemangioma is very likely to be misdiagnosed as the schwannoma and meningioma in imaging, the preoperative imaging should be carefully observed. It is recommended to inject methylene blue into the spinous process of the lesion segment before operation and locate the photos to help with precise intraoperative positioning. Once the disease is considered, special attention should be paid when opening the vertebral lamina to remove the epidural fat during the operation. The lesion is prone to bleeding, and is mistakenly believed to be absorbed by the aspirator or bitten together with the epidural fat. Total resection is an effective treatment for this disease, and it should be treated as soon as possible to avoid the influence of acute hemorrhage on the prognosis.

One case report of adrenal crisis with difficulty in weaning after lumbar spinal canal decompression surgery / 中华内分泌外科杂志

Adrenocortical crisis (AC) is a kind of endocrine emergency, often occurs in infection, shock, trauma, or postoperative, if the processing is not handling timely, can endanger patient's life.But as the disease is not common and the clinical symptoms are not typical,so it is easy to be misdiagnosis and missed diagnosis.This case was a "lumbar spinal canal decompression surgery" patient, who appeared postoperative confusion, oxygenation decline,and could not seperated from breathing machine, clinical manifestations were atypical.

Clinical effects and mid-term follow-up analysis of para-split laminotomy for lumbar spinal canal tumors / 国际外科学杂志

Objective:To investigate the surgical outcome and prognostic factors of para-split laminotomy for removal of lumbar spinal canal tumors.Methods:Retrospectively review the clinical data of 35 patients suffering lumbar spinal canal tumors, who underwent the para-split laminotomy for tumor resection in Department of Neurosurgery, Clinical Medical College of Yangzhou University from October 2016 to August 2019, including 16 males and 19 females, and the age was(40.1±10.6)years. Intraoperative blood loss, operation time, tumor resection, tumor pathological results, perioperative complications were observed. Follow-up situations, including tumor recurrence, bony fusion of laminae and spinal stability. Follow-up using outpatient examination and telephone interview was performed by the end of August 2022. The JOA back pain scoring system was used to evaluate the neurological function of the spinal cord, and paired t-test were performed to compare the overall preoperative and postoperative spinal cord neurological function scores. Linear regression and multiple linear regression were used to analyze the prognostic factors. Measurement data of normal distribution were expressed as mean±standard deviation ( ± s), and the comparison before and after operation was performed by paired t-test. Mearsurement data of skewed distribution were expressed as M( Q1, Q3). Count data were expressed as cases. Results:The tumors of 35 patients were resected completely. The median blood loss was 100(75, 140)mL and the average operative duration was (181.1±42.7) min. The postoperative pathological results were as follows: 24 neurilemmomas, 6 meningiomas, 4 ependymomas and 1 neurofibroma. There were no surgery-related complications occurred. The postoperative follow-up ranged from 36 to 69 months, with no tumor recurrence or spinal instability, and bony fusion of laminae seen in some patients on CT imaging. The overall spinal cord neurological function scores of pre and post operation were(19.5±3.4)versus(25.4±2.2), Paired t-test analysis revealed a significant difference between the overall postoperative spinal cord neurological function scores and the preoperative scores, and the postoperative scores were better than the preoperative scores( P<0.05). Multiple linear regression analysis showed a positive correlation between preoperative JOA scores and postoperative JOA scores, and postoperative JOA scores has negative correlation with tumor volume and the age at the time of operation ( P<0.05). Conclusion:Para-split laminotomy with less damage to the posterior spinal structures can effectively improve the neurological function of the spinal cord and protect the stability of the lumbar spine in patients with lumbar spinal canal tumors, and the better the preoperative neurological function of the spinal cord, the better the prognosis of patients, and the smaller the tumor volume, the better the prognosis.

One case of myeloid sarcoma with multiple space occupying lesions in the spinal canal / 中华神经科杂志

Myeloid sarcoma (MS) is a tumor mass formed by the proliferation of one or more myeloid primitive cells outside the marrow, which is mostly related to acute myeloid leukemia (AML). It is reported that 2.5% to 9.1% of AML patients have MS, and AML with spinal canal MS is very rare. Spinal canal MS often has an acute onset and is difficult to diagnose. It is easy to cause missed diagnosis and misdiagnosis, which will lead to a delay in accurate diagnosis seriously affecting the treatment and quality of life among these patients. The clinical data, diagnosis and treatment process of a case of MS with multiple space occupying lesions in the spinal canal diagnosed and treated by the Department of Hematology of Peking Union Medical College Hospital are reported, in order to provide reference for clinical workers.

The effect of intraspinal labor analgesia inlabor progress, maternal and infant outcomes / 中国医师进修杂志

Objective:To explore the effect of intraspinal labor analgesia on labor progress, maternal and infant outcomes.Methods:Two hundred cases of full-term singleton primiparous women in head position admitted to the Second Affiliated Hospital of Shantou University Medical College from March 2019 to March 2020 were selected as the research subjects. According to the random number table method, they were divided into the control group (100 cases, natural delivery) and the analgesia group (100 cases, analgesia delivery). The visual analoguescore (VAS), progress of labor, and the outcome of delivery between the two groups werecompared.Results:The VAS scores of the analgesic group at 10, 30 and 60 min after analgesia were lower than those in the control group: (1.30 ± 0.17) scores vs. (9.50 ± 0.53) scores, (0.50 ± 0.22) scores vs. (9.50 ± 0.16) scores, (0.40 ± 0.28) scores vs. (9.50 ± 0.34) scores, the differences were statistically significant ( P<0.05). The first stage of labor in the analgesia group was longer than that in the control group: (347.6 ± 54.4) min vs. (325.8 ± 58.5) min; but the active stage, the second stage of labor, the third stage of labor and the total duration of labor in the analgesia group were shorter than those in the control group: (184.3 ± 39.5) min vs. (202.9 ± 42.7) min, (57.8 ± 17.9) min vs. (85.3 ± 16.9) min, (7.7 ± 5.0) min vs. (16.3 ± 5.2) min, (503.6 ± 131.4) min vs. (596.5 ± 175.7) min, the differences were statistically significant ( P<0.05). The 2 h and 24 h postpartum hemorrhage in the analgesia group were significantly lower than those in the control group: (223.64 ± 80.34) ml vs. (276.97 ± 82.35) ml, (331.57 ± 92.47) ml vs. (384.59 ± 94.25) ml, the differences were statistically significant ( P<0.05). The rate of normal delivery and the use of oxytocin in the analgesia group were higher than those in the control group: 91.0%(91/100) vs. 75.0%(75/100), 83.0%(83/100) vs. 49.0% (49/100), the differences were statistically significant ( P<0.05). In the newborn Apgar scores, the muscle tension, pulse, reflex response, respiration score and total score in the analgesia group were significantly higher than those in the control group ( P<0.05). The neonatal distress in the analgesia group was lower than that in the control group: 4.0%(4/100) vs. 15.0%(15/100), the difference was statistically significant ( P<0.05). Conclusions:Intravertebral labor analgesia can shorten the time of parturient delivery, reduce postpartum hemorrhage, improve the Apgar score of newborns, increase the pregnancy rate, and improve maternal and infant outcome.

Efficiency and safety of traditional growing rod technique in the treatment of early onset dystrophic scoliosis secondary to type 1 neurofibromatosis with intraspinal rib head in children / 中华骨科杂志

Objective:To investigate the efficiency and safety of traditional growing rod in the treatment of early onset dystrophic scoliosis secondary to type 1 neurofibromatosis (NF1-DS) with intraspinal rib head in children.Methods:From September 2006 to May 2020, this study recruited 20 children with intraspinal rib head with early onset NF1-DS who had received traditional growing rods. There were 13 boys and 7 girls and the age of the initial operation was 7.0±1.6 years (range, 4.1-9.8 years). There were 7 cases of simple left chest bend, 9 cases of simple right chest bend, and 4 cases of double chest bend; 13 patients had varying degrees of kyphosis deformity. Two children had neurological symptoms before surgery, American Spinal Injury Association Impairment Scale (AIS) were grade D. The proportion of the intraspinal rib head (IRP), the Cobb angle of the main chest bend, apical vertebra rotation (AVR), apical vertebral translation (AVT), trunk shift (TS) and sagittal TK, lumbar lordosis (LL), sagittal balance and T 1-S 1 height were measured before and after first time internal fixation and at last follow-up, and the complications were also evaluated. Results:All 20 patients were followed up and the average follow-up time was 41.6±23.8 months (range, 24-99 months). A total of 85 operations was conducted including 63 protrude operations. After operation, the IRP was significantly lower than that before operation (preoperative 33.1%±17.5% vs. postoperative 22.2%±11.3%, P<0.001) and no significant correction loss was found at last follow-up 23.7%±12.4% ( P>0.05). The mean Cobb angle decreased from 75.9°±26.7° preoperatively to 45.0°±18.5° postoperatively ( P<0.001) and there was still significant improvement at the last follow-up (41.0°±17.2°) compared with postoperatively ( P<0.05). The AVR was significantly reduced after surgery compared with preoperatively (33.0°±10.1° vs. 39.3°±13.3°, P<0.001), and the last follow-up (40.1°±11.4°) was significantly improved compared with postoperative ( P=0.005). The T 1-S 1 height increased from 259.8±70.7 mm preoperatively to 296.9±78.4 mm postoperatively ( P=0.001), and at the last follow-up 296.9±78.4 mm was still significantly higher than after operation ( P<0.001), with an average annual increase of 12.4±3.2 mm. Significant correction of AVT, TK, LL and sagittal balance were noted after initial surgery ( P<0.05), and no significant correction loss was found at last follow-up ( P>0.05). There were 10 complications in 7 cases. There were 5 complications of pedicle screw loosening, 1 complication of bolt droping, 2 complications of broken rod, 1 complication of distal junctional kyphosis and 1 complication of adding-on phenomenon. 2 cases with nerve injury were recover after operation (AIS grading E). None of the children had new neurological complications during growth rod insertion and multiple stretching during follow-up. Conclusion:For children with early onset NF1-DS with intraspinal rib head, if the preoperative AIS grade is D or E, traditional growing rod technique is relatively safe and effective and can make the intraspinal rib head remove from the spinal canal partly.

The influence of the rib cage on the severity of thoracic spine burst fractures / Influência da caixa torácica na gravidade da fratura da coluna torácica tipo explosão / La influencia de la caja torácica en la gravedad de la fractura por estallido en la columna torácica

ABSTRACT Objective: To analyze the anatomic influence of the ribs related to the severity of thoracic spine burst fractures. Methods: A retrospective review of 28 patients with thoracic spine burst fractures hospitalized by the Spine Group of the Hospital Ortopédico de Passo Fundo between January 2002 and December 2016 was conducted. The kyphosis, vertebral collapse, and narrowing of the vertebral canal measurements were compared between patients who had fractures at the true and false rib levels (T1 to T10) and those with fractures at the floating rib levels (T11 to T12). Results: The kyphosis, vertebral collapse, and narrowing of the vertebral canal values, measured only for vertebrae pertaining to the rib cage, were low. In addition, there were no statistically significant differences between the measurements of the group of patients with fractures at the level of the true and false ribs (T1 to T10) and the group of patients whose fractures were at the level of the floating ribs (T11 and T12). Conclusion: The differences between the traumatic structural changes in the vertebrae with true and false ribs (T1 to T10) and the vertebrae with floating ribs (T11 and T12) were not significant in the present study. Level of Evidence II; Retrospective study.

RESUMO Objetivo: Analisar a influência anatômica das costelas sobre a gravidade das fraturas da coluna torácica tipo explosão. Métodos: Foi realizada uma revisão retrospectiva de 28 pacientes com fratura tipo explosão na coluna torácica, internados no período compreendido entre janeiro de 2002 a dezembro de 2016 pelo Grupo de Coluna do Hospital Ortopédico de Passo Fundo . As mensurações de cifose, colapso vertebral e estreitamento do canal vertebral foram comparadas entre os pacientes que apresentavam fraturas no nível das costelas verdadeiras ou falsas (T1 a T10) e aqueles com fraturas no nível das costelas flutuantes (T11 a T12). Resultados: Os valores da cifose, colapso vertebral e estreitamento do canal vertebral, mensurados apenas nas vértebras pertencentes à caixa torácica, mostraram-se baixos. Além disso, as mensurações não apresentaram diferenças estatísticas significativas quando foram comparados os grupos de pacientes que apresentavam fraturas no nível das costelas verdadeiras ou falsas (T1 a T10) com aqueles cujas fraturas eram no nível das costelas flutuantes (T11 e T12). Conclusões: As diferenças entre as alterações estruturais traumáticas nas vértebras com costelas verdadeiras e falsas (T1 a T10) e as vértebras com costelas flutuantes (T11 e T12) não foram significativas no presente estudo. Nível de Evidência II; Estudo retrospectivo.

RESUMEN Objetivo: Analizar la influencia anatómica de las costillas con respecto a la gravedad de las fracturas de la columna torácica por estallido. Métodos: Se realizó una revisión retrospectiva de 28 pacientes con fractura de columna torácica por estallido, ingresados en el período comprendido entre enero de 2002 y diciembre de 2016 por el Grupo de Columna del Hospital Ortopédico de Passo Fundo. Se compararon las medidas de cifosis, colapso vertebral y estrechamiento del conducto vertebral entre los pacientes que presentaban fracturas a nivel de las costillas verdaderas o falsas (T1 a T10) y aquellos con fracturas a nivel de las costillas flotantes (T11 a T12). Resultados: Los valores de cifosis, colapso vertebral y estrechamiento del conducto vertebral, medidos solamente en las vértebras pertenecientes a la caja torácica, se mostraron bajos. Además, las mediciones no presentaron diferencias estadísticamente significativas al comparar los grupos de pacientes que presentaban fracturas a nivel de las costillas verdaderas o falsas (T1 a T10) con aquellos cuyas fracturas estaban a nivel de las costillas flotantes (T11 a T12). Conclusiones: Las diferencias entre los cambios estructurales traumáticos en las vértebras con costillas verdaderas y falsas (T1 a T10) y las vértebras con costillas flotantes (T11 y T12) no fueron significativas en el presente estudio. Nivel de Evidencia II; Estudio retrospectivo.

Factores de mal pronóstico en pacientes geriátricos con lesión medular traumática

Introducción: El trauma raquimedular es una afección devastadora que cursa con alteraciones sensitivas, motoras y autonómicas, sin embargo, la sobrevida depende de factores pronósticos descritos en la literatura como son: la edad, las comorbilidades propias del individuo, la severidad del trauma inicial, el nivel y tipo de lesión ente otras. Objetivo: Evaluar los factores clínicos-epidemiológicos que afectan la evolución en los enfermos geriátricos portadores de lesión medular cervical traumática. Métodos: La investigación se realizó en un periodo de tres años, en el servicio de Neurocirugía y constó con varias etapas: se dedicaron dos años a la selección de los enfermos: enero 2018 a julio 2020, se completó el tiempo destinado al estudio con el seguimiento por consulta hasta los seis meses. Resultados: Predominó el grupo de 60 a 69 años del sexo masculino con un 56,6 % con dominio de los grupos de severidad A y B de la escala de ASIA. Los factores de mal pronóstico en el daño medular fueron los cambios degenerativos del raquis, el nivel de lesión baja y el alto índice de complicaciones entre otros. Como resultado, el grado de dependencia social en el grupo fue moderado o severo y los fallecidos fueron el 46,6 % de los casos tratados. Conclusiones: El trauma raquimedular cervical representa un evento complejo y multifactorial en el que influyen las comorbilidades, las características del evento traumático y el desarrollo tecnológico del centro. La valoración adecuada de cada uno de ellos puede mejorar los resultados para los lesionados de más de 60 años.

Introduction: Spinal cord trauma is a devastating condition that causes sensory, motor and autonomic alterations, however, survival depends on prognostic factors described in the literature such as: comorbidities of the individual, the severity of the initial trauma, the level of the injury, among others. Objective: To evaluate the clinical and epidemiological factors that overshadow the evolution in geriatric patients with traumatic cervical spinal cord injury. Methods: The research was carried out over a period of three years, in the Neurosurgery service and consisted of several stages: two years were dedicated to the selection of patients: January 2018 to July 2020, the time allocated to the study was completed with follow-up by consultation up to six months. Results: The group of 60 to 69 years of male sex prevailed with 56.6% with domain of severity groups A and B of the ASIA scale. Poor prognostic factors in spinal cord injury were degenerative changes of the spine, low injury level and high rate of complications among others. As a result, the degree of social dependence in the group was moderate or severe and the deceased were 46,6% of the cases treated. Conclusions: Cervical spinal cord trauma represents a complex and multifactorial event that is influenced by comorbidities, the characteristics of the traumatic event and the technological development of the center. Proper assessment of each of them can improve outcomes for those injured over 60 years of age.

Study Of Radiological Evaluation Of Cervical Spine In Marathwada Region

Background:Cervical vertebraeare the most crucially located and play a dynamic role in the mobility and protection of the vital parts of the central nervous system, they are prone to undergo degenerative diseases like spinal stenosis, cervical spondylosis etc.Hence it is important to know the exact dimensions of cervical vertebralbody and spinal canal in the diagnosis, prognosis and treatment of diseasesrelated tocervical spine and spinal cord.Material And Methods:Normal plain radiographs of cervical spine of two hundred adult subjects of known sex (one hundred males and one hundred females) and of known age group (between 18 to 50 years) studied for Antero-posterior diameter of vertebral body (AP-VB), Height of vertebral body (HT-VB)and Canal body ratio (CBR) in C3 to C7 cervical vertebrae. Data tabulated and analysed by using software statistical Package for Social Sciences(SPSS).Result:Higher mean AP –VB diameter andmean Ht -VB valuesare recorded in males as compared to females.Highermean Canal body ratio (CBR) was recorded in femalesascompared to males.Conclusion:Present study showed,higher mean value of(AP-VB),(HT-VB) in males as compared to females and found to be statistically significant indicating sexual dimorphism. Canal body ratio(CBR) showed slightly higher values in females as compared to malesand found statistically significant at C6 and C7 Levels.

Diagnosis and surgical treatment of symptomatic lumbar spinal epidural liposis / 中国骨伤

OBJECTIVE@#To explore diagnosis and surgical treatment of symptomatic lumbar spinal epidural lipoplasia.@*METHODS@#A retrospective analysis of 19 patients with symptomatic lumbar spinal epidural hyperplasia treated with hemilaminectomy and interbody fusion and internal fixation from February 2012 to November 2018 were performed, including 7 males and 12 females, aged from 48 to 72 years old with an average of (57.6±1.2) years old;the course of disease ranged from 6 to 60 months with an average of (18.6±5.1) months;plane requiring decompression:L@*RESULTS@#All patients were followed up from 12 to 37 months with an average of (16.3±3.8) months. Ninteen patients were successfully completed operation, and all adipose tissues in the compressed segment of the spinal canal were removed. Operation time was from 125 to 260 min with an average of (186± 15) min, and blood bleeding was from 150 to 500 ml with an average of (280±46) ml. Two patients occurred partial incision fat liquefaction and exudate did not heal, the incision was opened to remove effusion, the dressing was changed and anti-inflammatory treatments were performed. No complications such as cauda equina injury, cerebrospinal fluid leakage, and broken nails occurred. Preopertaive VAS of back pain and leg pain were 5.3±0.7 and 6.8±0.8, respectively, while 2.1±0.4 and 2.3±0.5 respectively at 6 months after opertaion, there were statisticalsignificant difference between 6 months after operation and before operation (@*CONCLUSION@#Patients with symptomatic lumbar spinal epidural lipoplasia undergo hemilaminectomy and internal fixation of compression segment could relieve compression of dura mater and cauda equina, and achieve good clinical results.

Effect of continuous saline irrigation during operation on the incision pain relief after posterior lumbar surgery / 解放军医学杂志

Objective: To explore the effect of continuous saline irrigation and cooling during posterior lumbar surgery using high-frequency electric knife to expose lumbar lamina on postoperative incision pain. Methods: A total of 34 adult patients with lumbar intraspinal tumor were included in present study who received surgical treatment from August 2017 to July 2018 in Changzheng Hospital Affiliated to Navy Medical University, and were randomly divided into irrigated group (n=17) and nonirrigated group (n=17). Patients in irrigated group received continuous normal saline irrigation for cooling surgical field, while those in non-irrigated group did not receive such treatment. The time required for exposure of bilateral lamina, the temperature of tissues around the electrosurgical scalpel, degree of thermal damage of muscle tissue, postoperative C-reactive protein level, the visual analogue scale (VAS) scores at 1st, 2nd and 3rd day after operation, and the amount of analgesics were compared between the two groups. Results: The time required for exposure of bilateral lamina was obviously longer in irrigated group than in nonirrigated group [(29.12±4.68) min vs. (24.94±3.23) min, P0.05) between the two groups. The VAS score and the amount of analgesics were obviously lower in irrigated group than in non-irrigated group at the 1st day after operation (P0.0.5) at the 2nd and 3rd day after operation. Conclusion: Continuous normal saline irrigation may reduce the thermal damage of muscle tissue to some extent after posterior lumbar surgery, and relieve the postoperative pain.

Relationship between thoracic and lumbar vertebral posterior wall morphology and bone cement leakage into the spinal canal during the percutaneous kyphoplasty / 中国组织工程研究

BACKGROUND: Percutaneous kyphoplasty (PKP) is an effective method for treating osteoporotic vertebral compression fracture. Although satisfactory clinical outcomes can be achieved, bone cement leakage is still one of the main complications of PKP. Based on previous studies, there are many high risk factors for bone cement leakage into the spinal canal; however, less attention to the posterior wall morphology of different vertebral bodies may be an important reason for bone cement leakage into spinal canal. OBJECTIVE: To investigate the effect of thoracic and lumbar vertebral posterior wall morphology in the patients with osteoporotic vertebral compression fracture on bone cement leakage into the spinal canal during the PKP. METHODS: The clinical data of osteoporotic vertebral compression fracture patients with PKP were selected. There were 98 osteoporotic vertebral compression fracture patients with CT scan and three-dimensional reconstruction image data from T6 to L5. The three-dimensional reconstruction of CT and multiplanar reconstruction were used to measure the depth of the concave vertebral posterior wall (OC) and the corresponding middle-sagittal diameter of the vertebra (PC) of the non-fractured vertebral body, the ratio of OC to PC was calculated. All subjects were divided into thoracic group (T6-T12) and lumbar group (L1-L5) based on the location of measured vertebral, and the differences of the OC between groups were compared. 357 patients (548 vertebrae) with osteoporotic vertebral compression fracture without CT three-dimensional reconstruction underwent PKP within the same period. They were also divided into thoracic vertebra and lumbar vertebra groups. The degree of bone cement leakage into the spinal canal was compared between thoracic and lumbar vertebra groups. RESULTS AND CONCLUSION: (1)The morphological parameters of posterior vertebral wall in 98 patients showed that the depth of the concave vertebral posterior wall gradually (OC) deepened from T6toT12, with an average of 4.6 mm. The depth became gradually shallow from L1 to L5, with an average of 0.6 mm. The ratio of the depth of the concave vertebral posterior wall to the corresponding middle-sagittal diameter of the vertebra was approximately 16% (1/6) from T6toT12. The average value of ratios from Li to U was 3%. The ratios in lumbar vertebra were significantly decreased compared with thoracic vertebra (16%, 1/6). (2) Results form 357 patients who underwent PKP at the same time showed that the rate of bone cement leakage into spinal canal was 10.2% (31/304) in the thoracic vertebra group during the PKP, and the rate of lumbar vertebra group was 3.7% (9/244). In the thoracic group, the average maximal sagittal diameter of the bone cement intruded spinal canal was (3.1 ±0.2) mm, the average maximal area of the bone cement intruded spinal canal was (30.8±0.3) mm2, and the spinal canal encroachment rate was (22.5±0.2)%. In the lumbar group, the average maximal sagittal diameter of the bone cement intruded spinal canal was (1.4±0.1) mm, the average maximal area of the bone cement intruded spinal canal was (14.9±0.2) mm2, and the spinal canal encroachment rate was (11,4±0.3)%. There was significant difference between thoracic and lumbar groups (P<0.05). (3) The above results imply that due to the presence of OC structure in the middle and lower thoracic vertebra, it is possible to reduce the occurrence of bone cement leakage into spinal canal through avoiding bone cement distribution over the posterior 1/6 (16%) of vertebral body in PKP. The effect of the difference between thoracic and lumbar vertebral posterior wall morphology in osteoporotic vertebral compression fracture patients on bone cement leakage into the spinal canal during the PKP may be one of the reasons why the rate of bone cement leakage into spinal canal in thoracic vertebra significantly higher than that in lumbar vertebra. The study protocol was approved by the Ethics Committee of the Affiliated Hospital of Southwest Medical University (approval No. K2018008).

Analysis of Preoperative Factors Affecting Postoperative Spinal Canal Expansion after Posterior Decompression for the Treatment of Multilevel Cervical Myelopathy / 대한척추외과학회지

STUDY DESIGN: Retrospective analysis OBJECTIVES: To evaluate preoperative factors related with spinal canal expansion after posterior decompression for the treatment of multilevel cervical myelopathy. SUMMARY OF LITERATURE REVIEW: Data about preoperative factors related with spinal canal expansion after posterior cervical decompression surgery are inconsistent. MATERIALS AND METHODS: We reviewed 67 patients with cervical myelopathy who underwent posterior laminectomy or laminoplasty. Radiologically, we evaluated the C2-7 Cobb angle and range of motion using X-rays from the preoperative assessment and final follow-up. Expansion of the spinal canal at 6 weeks postoperatively was evaluated using magnetic resonance imaging and compared with the preoperative values. The preoperative factors of age, sex, number of operated levels, operation method, and radiological parameters were investigated as factors potentially related to postoperative spinal canal expansion using multivariate regression and correlation analyses. The clinical outcome was analyzed by the Neck Disability Index (NDI) and Japanese Orthopaedic Association (JOA) scores. RESULTS: The postoperative spinal canal expansion was 4.76 mm in sagittal images and 4.31 mm in axial images, with higher values observed in males and cases of severe preoperative cord compression. A lordotic preoperative Cobb angle was related to postoperative spinal canal expansion and JOA score improvement, but without statistical significance. The clinical outcomes of NDI (18.3→14.8) and JOA scores (10.81→14.6) showed improvement, but were not significantly related with any preoperative factors. CONCLUSIONS: The amount of preoperative spinal canal stenosis was associated with postoperative spinal canal expansion after posterior decompression in multilevel cervical myelopathy. The preoperative Cobb angle was not related to postoperative spinal canal expansion or clinical improvement.

Progress in the application of posterior cervical lateral mass screw fixation / 国际外科学杂志

Posterior cervical lateral mass screw fixation refers to the surgical procedure for treating cervical vertebrae disease by inserting a needle into the lateral side of the cervical vertebra and achieving internal fixation to the cervical vertebrae by screws, connecting plates and the like. In view of the high degree of cervical vertebra activity and complex structure, adjacent to the cervical spinal cord and multiple nerves and blood vessels, the cervical spine is difficult to place and has a certain degree of risk, and the posterior cervical lateral mass screw fixation can effectively reduce the incidence of injuring the nerves and vessels. In recent years, the clinical research on the posterior approach of the cervical spine is more and more abundant. In order to facilitate the clinician to better understand the advantages and disadvantages of the procedure and the development direction of the new technology of dynamic tracking. Now, a review of the application of this technique in recent years is reviewed.

Microsurgery for spinal canal tumors: A clinical analysis of 145 cases / 第二军医大学学报

Objective: To explore the microsurgical treatment of spinal canal tumors and to analyze the strategies for clinical treatment of spinal canal tumors. Methods: Were retrospectively analyzed the clinical data of 145 patients with spinal canal tumors who were treated in our hospital from Dec. 2014 to Nov. 2016. Microscopic resection of tumors was performed with half lamina-, full lamina-, or lamina joint-fenestration. Spinal internal fixation was performed in 52 patients. The patients were followed up for 3-26 months. X-ray and magnetic resonance imaging were performed again in all patients, and computed tomographyed was performed in patients undergoing internal fixation. The spinal cord function was assessed by McCormick grade before operation, 1 week after operation and 3 months after operation. Results: Of the 145 patients, 127 underwent total resection, 16 underwent subtotal resection and 2 underwent partial resection. One patient with cervical intramedullary tumors developed kyphosis after operation and underwent reoperation. No screw rod dislocation or spine instability was found in the 52 patients undergoing spinal internal fixation. The McCormick grading was significantly better 1 week and 3 months after operation versus before operation (P<0.05). Conclusion: Microsurgery is an effective method for treatment of spinal canal tumors. Good intraoperative exposure and reliable spinal internal fixation are essential to reduce the complications after spinal canal tumor surgery.

Progress in the application of posterior cervical lateral mass screw fixation / 国际外科学杂志

Posterior cervical lateral mass screw fixation refers to the surgical procedure for treating cervical vertebrae disease by inserting a needle into the lateral side of the cervical vertebra and achieving internal fixation to the cervical vertebrae by screws,connecting plates and the like.In view of the high degree of cervical vertebra activity and complex structure,adjacent to the cervical spinal cord and multiple nerves and blood vessels,the cervical spine is difficult to place and has a certain degree of risk,and the posterior cervical lateral mass screw fixation can effectively reduce the incidence of injuring the nerves and vessels.In recent years,the clinical research on the posterior approach of the cervical spine is more and more abundant.In order to facilitate the clinician to better understand the advantages and disadvantages of the procedure and the development direction of the new technology of dynamic tracking.Now,a review of the application of this technique in recent years is reviewed.

Effect of nerve growth factor-beta on proliferation of intraspinal schwannomas / 中国组织工程研究

BACKGROUND: Existing evidence has shown that that the effect of NGF/TrkA signaling pathway on proliferation and differentiation of tumor cells is closely related to PI3 K/AKT signaling pathway in human benign and malignant tumors. However, there is little information on the NGF/TrkA signaling pathway in pathogenesis of intraspinal schwannomas. OBJECTIVE: To investigate the effect of nerve growth factor-beta on the proliferation of interspinal schwannoma cells and to explore on the pathogenesis of NGF/TrkA signaling pathway in interspinal schwannoma. METHODS: Tumor samples were collected and digested to obtain high purity tumor cells as experimental cells. Then the cells were given different concentrations of nerve growth factor-beta (15, 30, 60, 120 and 240 μg/L), K252 a (100, 200, 300, 400, 500 and 600 nmol/L), LY294002 (10, 20, 30, 40, 50 and 60 μmol/L), nerve growth factor-beta (120 μg/L) plus K252 a (TrkA inhibitor, 400 nmol/L), and nerve growth factor-beta (120 μg/L) plus LY294002 (P13 K inhibitor, 50 μmol/L), respectively, for a certain time. The cell proliferation was detected by MTT assay. TrkA, AKT, p-AKT (Ther308), p-GSK-3 beta protein expression was detected by western blot assay. TrkA and AKT mRNA expression was detected by RT-PCR. RESULTS AND CONCLUSION: (1) Compared with the control group, the absorbance value of cells in the nerve growth factor-beta groups was increased in a concentration-dependent manner (P ＜ 0.05), and increased obviously at the concentration of 120 μg/L (P ＜ 0.001). The absorbance value of cells in the K252 a and LY294002 groups was decreased continuously (P ＜ 0.05), and decreased obviously at the concentration of 400 nmol/L and 50 μmol/L, respectively (P＜ 0.001). (2) The expression levels of TrkA, p-AKT (Ther308), and p-GSK-3 beta protein were upregulated in the nerve growth factor-beta group (P ＜ 0.05), and the expression level of TrkA mRNA was upregulated (P ＜ 0.05). (3) In the nerve growth factor-beta (120 μg/L) plus K252 a (400 nmol/L) group, the absorbance value of cells decreased (P ＜ 0.001). The expression levels of TrkA, p-AKT (Ther308), and p-GSK-3 beta protein downregulated (P ＜ 0.05), and the expression level of TrkA mRNA downregulated (P ＜ 0.05). (4) In the nerve growth factor-beta (120 μg/L) plus LY294002 (50 μmol/L) group, the absorbance value of cells decreased (P ＜ 0.01), and the expression levels of p-AKT (Ther308), and p-GSK-3 beta protein downregulated (P ＜ 0.05). (5) There was no significant change in AKT protein and mRNA in each group (P＞ 0.05). (6) These results suggest that nerve growth factor-beta can promote interspinal schwannoma cell proliferation, which may be related to the expression of TrkA, p-AKT (Ther308) and p-GSK-3 beta protein in NGF/TrkA signaling pathway.

Hérnia medular idiopática atípica ­ relato de caso / Atypical Idiopathic Spine Cord Herniation (ISCH) ­ Case Report

A hérnia medular idiopática (HMI) é uma causa rara de mielopatia progressiva que afeta principalmente mulheres de meia idade com apresentação clínica típica com a Síndrome de Brown-Sequard. Possui etiologia incerta, sendo a teoria mais aceita a de ser um defeito congênito na dura-máter que leva a uma herniação lenta e progressiva da medula que ocasiona uma lesão evolutiva, podendo levar a um déficit irreversível quando subdiagnosticado e não tratado da forma ideal. A realização da ressonância magnética é fundamental para o diagnóstico, e a cirurgia é o tratamento de escolha para reverter e cessar os sintomas mielopáticos. O presente artigo mostra um caso de uma apresentação atípica da localização do defeito dural e da herniação, não descrita ainda na literatura, levando a uma apresentação neurológica e anatômica incomum para esta patologia, obrigando a realizar um planejamento cirúrgico específico para tal caso.

Idiopathic medullary hernia is a rare cause of progressive myelopathy, primarily affecting middle-aged women, typical clinical presentation with Brown-Sequárd Syndrome. Its etiology is uncertain, but the most accepted theory is that a congenital defect in the dura mater leads to a slow and progressive spinal cord herniation, causing an evolutionary spinal cord injury, which can lead to an irreversible deficit when underdiagnosed and not treated adequately. Magnetic resonance imaging is essential for the diagnosis, and surgery is the treatment of choice to reverse and stop myelopathy symptoms. The present article shows a case of an atypical presentation of the location of the dural defect and herniation, not yet described in the literature, leading to an unusual neurologic and anatomical presentation for this pathology, requiring a specific planning for this case.

Variations in the Torg-Pavlov cervical ratio with regard to age and sex: a comprehensive anatomical and morphometric study on contemporary cadaveric specimens / Variaciones en el índice de Torg-Pavlov cervical respecto a edad y sexo: un exhaustivo estudio anatómico en una población contemporánea

The Torg-Pavlov ratio is a method used to detect cervical stenosis. A Torg-Pavlov ratio ≤0.80 suggests significant stenosis. This ratio is obtained by dividing the anteroposterior diameter of the cervical canal by the anteroposterior diameter of the vertebral body. The aim of this study was to evaluate these parameters and determine if there are significant differences with respect to sex and age. This is an anatomical and comparative study in which 1020 cervical vertebrae from C2-C7 from an osteological collection were evaluated. We determined the anteroposterior diameter from the vertebral body, the anteroposterior diameter from the vertebral canal and the Torg-Pavlov ratio. The pieces studied were divided into groups according to sex and age, resulting in six groups of study. A statistical analysis was made to determine the significance of the differences between sex and age groups. The size of the vertebral body diminished form C2-C3 and increased from C4-C7. The canal diminished form C2-C4 and increased from C5-C7. The Torg-Pavlov ratio decreased from C2-C7. The body and the canal were higher in men, while the Torg-Pavlov ratio was higher in women. With age, in men, the size of the body increased, the canal maintained its size, and the Torg-Pavlov ratio diminished significantly. In the group of women ≥60 years, the size of the body decreased, and the canal and the Torg-Pavlov ratio increased. In men, the Torg-Pavlov ratio is determined by the vertebral body and canal, because these did not show differences in most of the age groups. While in women, it is determined mostly by the spinal canal because it presented more variability between the age groups.

El Índice de Torg-Pavlov se utiliza para la detección de estenosis del canal cervical. Un resultado ≤0.80 indica estenosis significativa. Se obtiene dividiendo el diámetro anteroposterior del canal cervical entre el diámetro anteroposterior del cuerpo. El objetivo de este estudio fue evaluar estos parámetros y determinar si existen diferencias significativas en relación con el sexo y la edad. Se realizó un estudio anatómico y comparativo, en el que se incluyeron 1020 vértebras cervicales de C2-C7 tomadas de una colección osteológica. Se determinó el diámetro anteroposterior del cuerpo vertebral, el diámetro anteroposterior del canal vertebral y el Índice de Torg-Pavlov. Las piezas evaluadas se dividieron en grupos de acuerdo al sexo y la edad, resultando en seis grupos de estudio. Se realizó un análisis estadístico para determinar si existían diferencias significativas entre estos grupos. El tamaño del cuerpo vertebral disminuyó de C2-C3 y aumentó de C4-C7. El canal disminuyó de C2-C4 y aumentó de C5-C7. El Índice de Torg-Pavlov disminuyó de C2-C7. El cuerpo y el canal vertebral fueron mayores en los hombres, mientras que el Índice de Torg-Pavlov fue mayor en las mujeres. Con la edad, en los hombres, el tamaño del cuerpo vertebral aumentó, el canal mantuvo su tamaño y el Índice de Torg-Pavlov disminuyo significativamente. En el grupo de mujeres ≥60 años, el tamaño del cuerpo disminuyó y el canal y el Índice de Torg-Pavlov aumentaron. En los hombres, el tamaño del cuerpo y el canal vertebral determinan el Índice de Torg-Pavlov, ya que estos no mostraron diferencias en la mayoría de los grupos de edad. Mientras que, en las mujeres, este está determinado principalmente, por el canal vertebral, porque este parámetro presento más variabilidad entre los grupos de edad.

Lumbar Spinal Canal Measurements By Magnetic Resonance Imaging (MRI) In Indian Population

Introduction: Lumbar spinal canal stenosis is the progressive narrowing of spinal canal that causes compression of nerve roots. Magnetic resonance imaging (MRI) is commonly used to assess patients with lumbar spinal canal stenosis. The aim of the study is to determine the normal sagittal and transverse diameter of the lumbar spinal canal and depth of the lateral recess in asymptomatic population by using MR imaging of the lumbosacral spine and to arrive at a reference lower limit of normal values at each level. Materials and Methods: This study was conducted on one hundred and five patients. MRI scan was performed on 1.5 T scanner. Measurements were performed on T1- weighted and T2-weighted fast spin echo sequences in axial and sagittal planes. Results: In our study narrowest mid sagittal diameter was at L4-L5 (10.9 mm) in males and L5-S1 (10.8 mm) females. There is no significant difference noted in the mid sagittal diameter and transverse diameter between males and females. Lateral recess depths showed a significant difference between the two groups at L2-L3 on right side and L4-L5 on left side. Conclusion: The mean values for the normal spinal canal diameters (SCD) and lateral rescess depth in our population are similar to data from other literature.